Psychological impacts such as anxiety, depression, posttraumatic stress disorder (PTSD), sleep disorders, substance misuse, elevated suicide risk, and family or relationship issues have long been associated with high-stress occupations, including some first responder professions (Berger et al., 2012; Boffa et al., 2017; Casas & Benuto, 2022; Jetelina et al., 2020; Jones et al., 2018; Lewis-Schroeder et al., 2018; McFarlane et al., 2009). Events such as the COVID-19 pandemic, the opioid epidemic, and mass casualties may intensify stressors among first responders. Firefighters, law enforcement officers, emergency medical services (EMS) professionals, and others may face longer hours, added responsibilities, and elevated exposure to potentially traumatic events (Ehrlich et al., 2020; Hoffman, 2020; Jozaghi et al., 2018; Klimley et al., 2018; National Institute for Occupational Safety and Health, 2021; Pike et al., 2019; Stogner et al., 2020). Meanwhile, many first responder communities are bolstering their efforts to develop, implement, and improve upon programs and policies supporting mental health and well-being.
Across jurisdictions, first responders can often receive mental health services, when needed, through several channels. One such avenue is employee assistance programs (EAPs), work-based initiatives offering wide-ranging services—including mental health treatment and referral—for individuals with personal or work-related concerns (Office of Personnel Management, n.d.). In addition, first responders with adequate health insurance coverage or ability to pay may seek care via mental health providers in the community (e.g., private practitioners), some of whom focus on first responder populations (Gulliver et al., 2019; Jones et al., 2020). Aside from treatment, per se, first responders may also participate in critical incident stress debriefing (CISD) or peer support activities, where available. CISD is a standardized activity used following a traumatic incident which seeks to educate about stress and coping, normalize stress reactions, promote emotional processing, and provide referral information (Klimley et al., 2018; Litz et al., 2002). It is one component of an umbrella approach to crisis intervention known as critical incident stress management (CISM). Peer support programs train selected first responders to provide social and emotional support to peers in distress due to occupational or personal factors (Klimley et al., 2018; Jones et al., 2020). Both programmatic activities are widely (though not universally) available and can facilitate early intervention and referral to treatment. In addition, chaplain programs and spouse support programs sometimes augment or work in conjunction with first responder mental health or well-being programs (National Alliance on Mental Illness, 2023; Ramchand et al., 2019).
Public and organizational policies have also been developed or expanded to address the mental health and well-being of first responders. For example, the State of Ohio passed legislation in 2021 to examine expanding eligibility for workers’ compensation benefits for first responders suffering from PTSD (H.B. 308, 2021). In addition, Ohio implemented a state-level office focused on the well-being of first responders to coordinate specialized support and training (Ohio.gov, 2021). Local policies have also emerged. For example, the city of Cleveland and local union representatives negotiated a collective bargaining agreement in 2019 enabling emergency medical technicians (EMTs), paramedics, and dispatchers to request and receive at least one hour off duty to decompress after potentially traumatic events (Ohio State Employment Relations Board, 2019). At the federal level, members of Congress introduced legislation in 2022 (S.4007) and 2023 (H.R.472) aimed at establishing a program making state-of-the-art treatment and preventive care for PTSD or acute stress disorder widely available to first responders (Fighting Post-Traumatic Stress Disorder Act, 2022; Fighting Post-Traumatic Stress Disorder Act, 2023). Moreover, increased federal attention has been placed on the issue of first responder suicide (e.g., Tiesman et al., 2021; Helping Emergency Responders Overcome Act, 2021).
Despite proliferation of mental health programs and policies for first responders, literature on the implementation and overall extent of these efforts is limited (Spence et al., 2019). At least a handful of studies have assessed factors that help or hinder mental health program implementation (e.g., Knaak et al., 2019; McKeon et al., 2021). Studies have also examined related topics such as barriers to obtaining mental health services (e.g., Haugen et al., 2017; Jones et al., 2020) and the effectiveness of mental health programs (e.g., Thompson & Drew, 2020; Boothroyd et al., 2019). However, most such studies tend to focus on a specific program—often its outcomes—rather than the larger landscape of programs and policies. Accordingly, little is known about factors promoting or inhibiting mental health program or policy advancement as well as the existence (or absence) of programs and policies across jurisdictions. Without adequate research in these areas, policymakers and organizational leaders may lack insights crucial to program or policy development or implementation. Thus, the goal of this exploratory research is to assess how first responders involved in mental health program or policy activities in one U.S. state (Ohio) are responding to mental health issues.